Medical Coding Error Leads to Media Vigilante Action

A man in Illinois was the unfortunate beneficiary of a medical coding error that caused his insurance company to deny payment of his treatment. Luckily for him, a consumer watchdog at a local newspaper sprung into action.

The story is a cautionary tale for medical coding and billing departments who are mindful of public sentiment.

According to a story in the Chicago Tribune, a patient at Loyola University Medical Center in Chicago went to his doctor in August for a physical, including blood work. Pretty standard stuff. But due to an error on the doctor’s office’s part, he was only able to get the blood work that day.

When his bill arrived, the billing for the lab work done on the blood was coded as “obesity monitoring.”

The patient had halved his body weight five years prior, dropping down to 180 pounds (and he kept the weight off), probably leading to the incorrect coding. Had he done the full physical that day, it most likely would have been a part of the physical.

And, of course, the patient’s insurance company did not cover costs associated with “obesity monitoring.” After two attempts to get the correct coding – during which the hospital actually conceded the error, but still re-submitted the wrong coding — the frustrated patient contacted the consumer action desk of the Chicago Tribune.

After a call from “The Problem Solver” at the Tribune, the hospital quickly changed the coding and sent the correct bill to the insurance company.

But this kind of coding complacency can lead to public relations headaches for medical providers. When a patient is questioning the coding of a procedure and someone in coding agrees to an error, it’s probably best to fix it immediately.